Outbreaks of Meningitis, Measles Strike Districts

Outbreaks of bacterial meningitis and measles have struck several
school districts in recent weeks, disrupting activities and killing at
least two students.

The swift spread of disease through a school or district quickly
strains the resources of administrators suddenly faced with angry and
confused parents, seriously ill students, and a host of health-related
concerns.

In Mankato, Minn., officials scrambled to vaccinate more than 7,000
students, employees, and family members after a meningitis outbreak
killed one student and sent several people to the hospital.

A 15-year-old Mankato West High School sophomore died Feb. 3 after
becoming infected with the bacteria that causes meningoccal meningitis,
an inflammation of the brain and spinal cord. After his death, health
officials placed all Mankato West students and their families on an
antibiotic, rifampin, that kills the bacteria.

A similar outbreak last month killed a student at Episcopal High
School, a private boarding school in Alexandria, Va. A second student
from a Norfolk, Va., school who attended a track meet at Episcopal has
been hospitalized.

Confronted with sudden serious illnesses, educators must make some
quick decisions.

"You need to get the key players in your community together--and
fast," said John Barnett, the principal at Mankato West High. That
means school administrators, municipal officials, and public-health
authorities, he said.

On the advice of the state epidemiologist, Mankato officials decided
not to close the school. Students "probably have closer contact out of
school than they do in school," Mr. Barnett said last week.

Following the student's death, attendance plummeted to about 30
percent, Mr. Barnett said, but climbed steadily thereafter. Though they
kept school open, Mankato West officials suspended the attendance
policy and offered make-up assignments.

Taking a different tack, a tiny one-school district in central Texas
last month bowed to worries over five meningitis cases and shut its
doors for eight school days.

The disease felled three students, a parent volunteer, and the
superintendent in the 240-student Jonesboro district, said Tom Rhea,
the principal of Jonesboro School. The adults and one of the students
had been on the same field trip to Fort Worth.

"Parents were keeping their kids home in droves," he said.

Quick Responses

Once initial decisions are made, school officials then must worry
about containing the disease.

During the forced break, Jonesboro School held a vaccination clinic
that drew 650 people from in and around the 500-resident farming and
ranching community west of Waco.

In Alexandria, Episcopal High School administrators decided to go
beyond the recommendation of the local health department and offer
rifampin to all faculty members and 400 students.

The actions a school should take during a meningitis outbreak depend
on working with public-health officials to identify what strain of the
disease is at work and who is likely to be at risk, said Dr. Jay
Wenger, the chief of the childhood- and respiratory-diseases branch of
the federal Centers for Disease Control and Prevention in Atlanta.

The C.D.C. does not recommend closing school for meningococcal
meningitis, he said.

In Grand Junction, Colo., officials administered about 8,000
immunizations after a bout with 50 cases of measles among students and
teachers, said Merritt Vanderhoofven, a co-director of pupil services
for the Mesa County Valley School District #51.

Since the outbreak in December and January, district officials are
considering changing their immunization policy. Colorado law requires
students to have had their first measles-mumps-rubella immunization
before they enter kindergarten, and the second shot is not required
until entry into 7th grade.

But during the epidemic, the students who came down with measles
were those who had had the first but not the second measles shot.

During the crisis, students were told to stay away from a district
high school if they had not had the second measles shot. And a handful
of students who for religious reasons would not get the shot took their
lessons home.

"What we had was an epidemic," Mr. Vanderhoofven said. "Parents
recognized this as not only a matter of protecting [their] own
children, but protecting other children."

Parental Concerns

Keeping parents informed is crucial in such emergencies, officials
said.

"You've got to be candid with people," said Mr. Barnett of Mankato
West High. "If there's any sense among the public that you're not
telling the truth, they'll eat you alive."

At two community meetings held at Mankato West--the second of which
drew 1,500 people following the student's death--parents expressed
concern about keeping school open.

In Jonesboro, one reason officials there closed school was because
they believed the community needed a "cooling off" period, Mr. Rhea
said. "There just wasn't enough information out there to allay the
fears."

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